Study: Major home dialysis barriers not the same for patients, caregivers and providers
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Key takeaways:
- A major patient- and care partner-perceived barrier was fear of performing home dialysis.
- A key provider barrier was poor patient education.
The top three home dialysis barriers cited by patients, caregivers and providers do not fully overlap, which suggests the need for diverse strategies for each group, according to a study.
“Implementation strategies to increase home dialysis use should be informed by an understanding of major barriers to home dialysis from the perspectives of patients, care partners and providers,” Yuvaram N.V. Reddy, MBBS MPH, of the University of Pennsylvania, wrote with colleagues. “Prior work has relied on expert opinion to produce a descriptive list of barriers to home dialysis. While such lists help establish a broad understanding of the field, without knowing which barriers to prioritize, it has been challenging to develop effective implementation strategies to expand home dialysis use.”
Researchers conducted a convergent parallel mixed-methods survey to analyze key obstacles in home dialysis. The national IM-HOME study formed a seven-member advisory board of patients, care partners and providers who highlighted major challenges in care.
With a group consensus on barriers, researchers created a survey, distributed through the American Association of Kidney Patients and the National Kidney Foundation, which garnered responses from 522 participants (233 providers and 289 patients/care partners).
The survey asked participants to rank their top three major barriers as a quantitative measure, as well as describe any perceived challenges in home dialysis for qualitative measure.
The top three patient and care partner barriers were fear of performing home dialysis, lack of space and the need for home-based support, according to the findings. Meanwhile, the top three provider barriers were poor patient education; limited mechanisms for home-based support staff, mental health and education; and lack of experienced staff.
Researchers also identified nine qualitative themes including limited education, financial disincentives, limited resources, high burden of care, a built environment/structure of care delivery favoring in-center hemodialysis, fear and isolation, perceptions of inequities in access to home dialysis, provider perspectives of patients and patient/provider resiliency.
The findings suggest “patients/care partners and providers have distinct but potentially complementary perspectives about major barriers to home dialysis, which highlight the need to develop implementation strategies that simultaneously address major patient-, care partner-, and provider-perceived barriers to home dialysis,” the researchers wrote.
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